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Healthcare IT Leaders Share Learnings from Recent Hurricanes

March 9, 2018
by Mark Hagland
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Healthcare IT Leaders from Puerto Rico, Florida, and Texas shared insights on the devastation of Hurricanes Harvey, Irma, and Maria

What can be learned from natural disasters, from the healthcare IT standpoint? As it turns out, a lot can. At a session held on Wednesday during HIMSS18, held this week at the Sands Convention Center in Las Vegas, healthcare IT leaders from different communities shared their perspectives on some of what happened during and after Hurricanes Irma, Maria, and Harvey last year.

As the session description of Session 64, “Learning from the Devastating Effects of Three Hurricanes: The Critical Role of Health IT,” summarized it, “During the 2017 hurricane season, Mother Nature launched an all-out assault on portions of Texas, Florida, Puerto Rico and the Virgin Islands.  With harsh winds, heavy rain resulting in historic flooding, and the aftermath that affected every aspect of human existence, there are lessons for all to learn regardless of the type of natural disaster. From a health IT perspective, many prepare for a potential disaster across infrastructure, communications, and alternatives to patient care delivery that organizations hope never occur. However, in the case of Hurricanes Harvey, Irma, and Maria, it affected every aspect of healthcare operations.”

José L. Abrams Guzmán, CIO and CTO at Servicios de Salud Episcopales, a health system based in Ponce, and anchored by Hospital San Lucas Ponce, a 161-bed community hospital, shared with the audience the devastating experience of Hurricane Maria, which hit Puerto Rico in September, just days after Hurricane Irma had hit the island. “We have 3.4 million people in Puerto Rico,” he noted. “Being an island presents a lot of challenges, because of the distance, and also around health services.”

What’s more, Abrams Guzmán noted, “We had activated our contingency plans” when Maria hit. “The problem is that we probably think that the worst that is going to happen is being cut off for a two-week period”; and in fact, as everyone now knows, the effects of Hurricane Maria have lasted even through the present. Among the issues related to that: “an old and susceptible power infrastructure with a median age of power plants equal to 44 years. Still recovering from Irma, two weeks earlier, about 80,000 people remained without power while Maria approached,” Abrams Guzmán noted. “Yes, 450 shelters opened on the afternoon of September 8,” he recounted. “By September 19, at least 2,000 people in Puerto Rico had sought refuge.”

Among the key operational challenges: “There was no information during or immediately after the emergency, and only one AM radio station was on the air. No communication between and among clinicians, administration personnel, service providers, suppliers, police stations, and emergency responders, was possible.” Meanwhile, “Airports and marine ports were paralyzed. And, as healthcare services, we weren’t the priority for emergency responders.” What’s more, he noted, “Everything had to be paid for in cash.”

What was learned from the experience of Hurricane Maria? In fact, Abrams Guzmán told the audience, “We learned a lot of things. First, we need to be prepared for a completely isolated situation, and consider the worst-case scenario, that of a power and communications loss of 100 percent.” Prior to Maria, he said, “we had usually prepared to manage a two-week period of an emergency.” That no longer appears realistic going into the future.

What’s more, Abrams Guzmán said, “During the recovery process, both electricity and communications may fail intermittently. Indeed,” he said, “we’re still having problems with power and communications.” What’s more, “After the emergency, we need the ability to install an alternate regional communications system. If you don’t have communications to transfer patients from one location to another, how can you manage that?”

Among the actions that should be considered in the future, Abrams Guzmán said, are these: “A regional repository of patient data should be considered for cases where access to the EHR [electronic health record] is lost. What about all the data?” Also, “We have processes to manage the situation on paper, but what about the data of the patient? We should establish regional centers to maintain data.” In addition, he said, “We need to maintain good relationships with service providers, which is the only way to ensure you’re one of their priorities.” Further, he said, “You need 3X redundancy in power. We had 3X redundancy in power at our hospital, which is better than 2X. That’s better both in power generators and communications.”

In addition, he said, “During emergencies, improvisation is allowed. Technology allows us to redesign during the recovery process.” And, he said, “the choice of cloud versus onsite data centers, must be evaluated.”

Kendall Brown, a member of the board of South Florida HIMSS, spoke about the impact of Irma. “To begin with,” said Brown, an enterprise sales executive at Allscripts, “6.3 million Floridians were advised to evacuate; I was one of them. Getting out wasn’t an issue, but getting back in was.” Further, she noted, “Nearly 12 percent of the states’ more than 300 hospitals closed, primarily as precautionary measures.”

Among the many challenges of Irma in Florida: “A diversity of residents, and multi-language barriers involving the use of technology applications. Also,” she said, “we have residents from various countries; and not everyone has a signal or Internet access.”

Also, Brown noted, “Some residents were trapped in areas with no access to electricity, which means no power, no Internet, and no access to electronic health records.” In addition, she noted, “Some areas lost power for one to three weeks. And of course, loss of power limits the use of health IT.”

Other issues particular to Florida: “We faced a water issue with storm surge. Storm surge impacts the ability to provide healthcare services, as some highways and other roadways, and other areas were flooded. We also had issues around excessive wind. And the combination of wind and water was particularly challenging, given that overland wiring is still prevalent in Florida. Wind damage particularly impacted overland lines, resulting in extensive power outages for extensive periods of time, while there was water damage to more isolated areas.”

All of these types of damage made things difficult, in that, as Brown put it, “People’s expectations are that technology is ‘always on’—and those expectations have increased,” in the present day.

One thing that helped a great deal, Brown said, was “non-traditional interoperability, like telemedicine. Several vendors made telemedicine services available at no cost.” Her own company, Allscripts/Surescripts, provided 12 months of medication history, via a cloud-based smartphone app.

In the future, Brown said, healthcare IT leaders should carefully consider blockchain when planning for natural disasters. “They should explore how to create a minimal shared view of data that is viewable by all providers, payers, and responders. And they should use the cloud in order to not rely on data that has been stored in a potentially compromised hospital location.”

Analyzing Harvey’s impact, suggesting preparations for the future

Jim Langabeer, a professor of health informatics and management at the University of Texas Health Science Center at Houston, shared with the audience that he is currently doing research on disasters and emergencies, and on “how we can do better.”

With regard to Hurricane Harvey, which devastated southeast Texas last August, Langabeer noted, “Harvey brought over five feet of rain to Houston and southeast Texas in less than two days. We had over $125 billion in storm damages, and more than 40,000 people were displaced, while nearly 350,000 area residents lost power. Dozens of hospitals were forced to evacuate, while our largest county hospital saw its EMS bays and first floor totally flooded, resulting in the needed diversion of patients from that hospital to others.” In addition, he noted, “The area’s two largest sports arenas became shelters” for residents displaced by the storm.

Among the recommendations he is studying for the future: community-wide data coordination plans; integrated, patient-level dashboards in shelters; regional health information exchange; better patient-level analytics, available at the point of care during disasters; improved patient communications and portals; and a coordinated social media strategy.

 

 


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Research: AI, Automation Reshaping Healthcare Technology Support

December 6, 2018
by Heather Landi, Associate Editor
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Supporting an evolving, complex technology stack along with the needs of both internal and external customers is not easy for IT vendors. Moving forward, emerging technologies, such as automation and artificial intelligence (AI) will redesign the way in which tech support firms function, according to a Black Book Research survey.

As a result of new and emerging technologies, support operations will look significantly changed from what exists in 2018, according to the research report.

“IT support will become much more customer-facing, but also much more robotic,” Doug Brown, Black Book Research managing partner, said in a statement. “The power of automation and the rise of the patient experience are disrupting an idling tech support sector as vendors restate relevance in the client services space.”

AI, chatbots and other forms of automation are now grabbing attention within most of the systems targeted at the healthcare IT support industry, but there's not a lot of companies employing them, according to Black Book’s research. Only 3 percent of healthcare providers and 5 percent of payers responding to the Black Book survey have launched automated client service strategies. 

“Healthcare tech support is on the cusp of change and as healthcare technologies evolve and improve, they are likely to reshape the very nature of what is client services and tech support,” Brown stated.

With innovations like AI-powered conversation platforms, tackling challenges in natural language understanding and context resolution, healthcare tech support firms will be able to create advanced virtual agents that retain deep knowledge about supported products.

“Clients will be able to provide end users with a new way of interacting with support services beyond the help desk,” Brown said.

There also is a shift from an exclusively internal focus to an external focus, as delivering and support a superb customer experience is becoming the primary driver of competitive advantage for healthcare organizations.

"As technology becomes more profoundly entrenched into every turn of the healthcare consumer journey, vendors are also beginning to realize that the traditional internally-focused support organization may be best suited to help their provider clients successfully shift their focus to consumers,” Brown said.

Eighty-eight percent of CIO respondents reveal they are beginning to re-imagine the role of the support organization as they recognize technology is now critical to the patient experience and that their existing support teams are not well positioned to provide the best support, the survey findings indicate.

Blockchain, which offers a shared, distributed, and decentralized ledger that serves as a foundation for trusted collaboration among multiple parties throughout the tech support processes, also will play a role in this area. The next wave of innovations will be focusing on standardizing blockchain solutions that can be seamlessly integrated with organizations' IT systems to jointly drive the tech support ecosystem, according to Black Book Research.

The increasing role of Big Data and the Internet of Medical Things also will fundamentally change the technology support functions. Healthcare organizations are growing increasingly dependent on big data direct their initiatives. This tsunami of data requires more computing power, more hardware, more network capacity and more devices, both traditional and mobile, along with the need for ongoing maintenance of cloud infrastructure, servers, desktops, laptops and storage and network devices, according to the report. This will require IT vendors and managed services providers to have a deep pool of skilled subject matter experts available to proficiently service clients and also maintain the certifications to support multiple manufacturers' hardware, storage devices, operating systems, and networks.

With regard to IoT devices, as this technology expands to meet the needs of the industry, service desk teams are given the opportunity to specialize and research better ways to manage these devices and ensure they are under their control, and return value, and not risk to any environment.

More sophisticated tech support also will be necessary to support enhance patient care, according to the research. Eighty-eight percent of clinicians responding to the survey assert their delivery of patient care services are continually impeded by subpar user tech support, increasing nearly ten percent from last year's survey. Ninety percent of hospital chief medical officers surveyed asserted multi-level tech support from their health records vendor ranging from help desk through engineering interventions will be a leading competitive inpatient electronic health record (EHR) differentiator in 2019.

Of the 92 percent of hospital respondents that view high quality user support as a make or break feature in a vendor relationship, 60 percent say their tech support (both EHR firm provided and from EHR tech support outsourcing partners) are currently falling short in their responsibilities to ultimately allow patient care improvements through well trained delivery personnel.

Eighty-three percent of hospital tech managers prefer that their EHR deliver direct, comprehensive tech support, not push the responsibility to third parties or on the hospital system itself as the only options. Eighty-one percent of those clients employing third party outsourcing tech support are significantly dissatisfied with the level of response and the quality of their services in the twelve months following go-live. Clients could potentially be leveraging one vendor for their help desk services and another for their upgrade services and so on which can lead to an overall disparate support strategy, according to the report.

“The increasing complexity of healthcare technology has made it even harder for an in-house help desk team, especially in small and medium sized communities to have sufficient expertise to meet all of an organizations' tech support needs,” Brown said.

Enterprise tech support is a highly complex and niche area in healthcare, where specialists can make a big difference in client loyalty by catering from Level 1 to Level 4 product support to ensure all the provider's business goals are aligned with technology readiness.

Vendors scoring highest among the four comprehensive levels of technical support are Cerner, Allscripts and MEDITECH.  The majority (84 percent) of tech support for Epic clients were attributed to third party outsourcers, consultants, and independent tech support firms working in Epic Systems client facilities.

 

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RSNA 2018: Imaging’s Resurgence?

November 29, 2018
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Today wraps up the 104th annual Radiological Society of North America (RSNA – www.RSNA.org) meeting.  Mother Nature made it a challenging place to get to early in the week, but from all accounts, attendance was on par with the past few years. 

From an imaging informatics perspective, this year saw a number of things that point to a resurgence in imaging.  It also presented some disappointment with respect to how the imaging vendors are dealing with a changing healthcare environment.

Artificial Intelligence – the obvious

Let’s begin with the 600-pound gorilla in the room, and that would be Artificial Intelligence (AI).  By all accounts, if you were to sum up this year’s meeting, AI everywhere would be how one would describe it!  AI has been a topic of discussion for several years now, initially driven by IBM’s Watson Health initiative. 

In prior years, there was considerable talk about how AI was going to revolutionize Radiology, and potentially replace the radiologist.  This year, the emphasis seemed to really shift from the “pie-in-the-sky” discussion to real-world, commercially available solutions.

A key development conundrum has been how to commercialize AI.  Academic centers represent a first line of research into AI applications, while “boutique” companies have struggled with how to get developments to market.  Large imaging informatics companies have likewise wrestled with how to approach bringing AI applications to market.  The solution prevalent this year seems to be for both large and small companies to offer a “platform” for the implementation of AI.  By supporting such capabilities as software development toolkits (SDK’s), vendors are providing a means for commercialization of academic and third-party applications without themselves reinventing the wheel.

The AI “store” borrows from the way smart-phone applications have evolved by providing the infrastructure for the validation and distribution of AI applications.  What is not yet clear is the liability of providing access to other entity’s applications.  Is the Store vendor responsible for the application, or the developer?  Who files for and secures FDA approval?  Given that the objective is for these external applications to interoperate with the vendor’s imaging informatics system, there is some development risk on the part of the distributing company, and potentially a shared liability as well.  Only time will tell how effective this strategy is.

Depending on who you ask, AI primarily is perceived as clinical tools to improve the radiologist’s interpretation efficiency, not as a replacement to the radiologist from a clinical perspective.  Conversely, there were a number of applications that make use of AI technology to enhance the way information is handled and presented, and the way it impacts the decision process.  Much of this revolves around the way information is collected and made available to the clinician, such as retrieving relevant lab and other study information. 

One interesting example might be Siemens Healthineers’ Proactive Follow-up application (https://usa.healthcare.siemens.com/healthineers-population-health-management/value-based-care/proactive-follow-up-for-incidental-findings).  It uses natural language processing to identify incidents of follow-up, such as “repeat CT exam in six months.”  Incidents requiring follow-up are summarized in a “dashboard” presentation to enhance the ability of imaging services to coordinate with the necessary clinical services to ensure that the follow-up recommendation is followed through.  While not as “sexy” as an AI image processing algorithm, it may have just as much if not more impact on imaging services’ efficiency.

AI will influence imaging in another way by fostering greater use of the cloud.  To maximize availability and accessibility, the cloud appears to be the major means for the deployment of AI applications.  Some vendors are also increasingly moving to the cloud for their entire enterprise imaging informatics applications.  Such non-traditional players as Intel and Google are becoming a greater factor in terms of how imaging is secured and managed, and AI appears to be an influencing factor. 

Clinical Decision Support – the not so obvious

While major emphasis was on AI, less emphasis seems to have been given to Clinical Decision Support, and the associated mandates.  The Protecting Access to Medicare Act of 2014 (PAMA) originally directed CMS (Centers for Medicare and Medicaid Services) to require Appropriate Use Criteria (AUC) consultation for Advanced Diagnostic Imaging procedures beginning Jan 1, 2017.  The mandate has now been delayed to January 1, 2020, which isn’t that far away!

Imaging companies correctly point out that clinical decision support will be more a function of the electronic health record (EHR) system, and they don’t seem to be particularly concerned with how it will impact imaging applications, with a few notable exceptions.  Change Healthcare (https://www.changehealthcare.com/) has been reformulated over the past few years from a “back office” services company to one encompassing imaging through the acquisition of McKesson’s imaging business.  More recently, Change acquired National Decision Support Company (http://nationaldecisionsupport.com/) to address the PAMA mandates by means of synergy between its product lines. 

Similarly, Siemens Healthineers acquired Medicalis, which was also focused on clinical decision support tools.  Collectively, these two vendors seem most aggressive in addressing the intersection of imaging services and the changing landscape of healthcare management.

Value-Based Care – another not so obvious

Healthcare providers are moving away from fee-for-service models to value-based care models of healthcare delivery.  These changes will ultimately impact imaging services, yet there appeared to be little direct emphasis amongst exhibitors. 

Part of this conundrum may be the perception that much of the informatics needed to address value-based care will be encompassed within the EHR.  On the other hand, imaging vendors seem to be more focused on the “mechanics” as opposed to the topic of value-based care.  For example, analytics tools and intelligent worklists are mechanisms that will help enable radiology to support value-based care, but they are not necessarily emphasized as such.

Consolidation and New Players

The industry continues to be a study in competitive dynamics, in that certain segments demonstrate further consolidation, while other segments continue to expand.  The area of workflow orchestration has seen a transition from “incubator” companies such as Clario, Primordial, and Medicalis to complete absorption by large imaging vendors.  Siemens Healthineers previously acquired Medicalis, and Nuance acquired Primordial.  The surprise announcement at this year’s meeting was the acquisition of Clario by Intelerad (https://www.intelerad.com/en/press-releases/intelerad-medical-systems-acquires-clario-medical/).  This now means all three of the key workflow orchestration vendors are part of larger imaging informatics organizations, and can leverage those capabilities as part of their offerings.

On the other side of the spectrum was the dramatic introduction of United Imaging Healthcare (https://usa.united-imaging.com/united-imaging-healthcare-makes-u-s-market-debut-at-rsna-2/) into the U.S. market.  United made their entry with one of the larger exhibits, and a dramatic first-day unveiling.  While operating in other world markets prior to this year, United has made a large investment by establishing a U.S. presence.

For a number of years, the imaging industry has lived in the shadow of the EHR, as providers scrambled to address government mandates for electronic health records.  Now that much of that infrastructure is in place, it appears that imaging informatics may be well-positioned to capitalize on further investment to support the EHR.  AI appears to be the first recipient of that emphasis.  From my vantage point, there will need to be a further shift to emphasize applications and solutions that support consolidation and value-based care trends.  It will be intriguing to see if these areas receive more emphasis at RSNA 2019!

 

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At RSNA, Imaging Informatics Sage Joe Marion Offers Straight Talk on this Moment in Imaging IT

November 28, 2018
by Mark Hagland, Editor-in-Chief
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Industry observer Joe Marion shares his insights on the path forward into the imaging informatics future

Joe Marion, a principal in the Waukesha, Wis.-based Healthcare Integration Strategies LLC, has participated in 42 RSNA Conferences—probably among the most of any current attendee. No one has a broader perspective on the imaging informatics vendor market than Marion, who spent years on the vendor side before shifting over to consulting a number of years ago.

As in recent past years, Marion sat down at this year’s RSNA Annual Conference, being held at Chicago’s vast McCormick Place Convention Center, and sponsored by the Oak Brook, Ill.-based Radiological Society of North America, on Tuesday afternoon, to speak with Healthcare Informatics Editor-in-Chief Mark Hagland. Below are excerpts from that interview.

What’s your overall impression of the exhibit floor at this year’s RSNA?

Well, obviously, the one buzzword that’s everywhere is artificial intelligence. The reality is that I think it means different things to different people. The difference between last year and this year is that some things are coming to fruition; it’s more real. And so some vendors are offering viable solutions. The message I’m hearing from vendors this year is, I have this platform, and if a third party wants to develop an application or I develop an application, or even an academic institution develops a solution, I can run it on my platform. They’re trying to become as vendor-agnostic as possible.


Joe Marion

Meanwhile, outside of one vendor, I’m not really seeing a whole lot of emphasis this year on value-based care; that’s disappointing. I don’t know whether people don’t get it or not about value-based care, but the vendors are clearly more focused on AI right now. And that’s surprising to me in terms of some of the mandates, for example, for referring physicians to soon use clinical decision support—that’s important. [Here, Marion referred to the Protecting Access to Medicare Act (PAMA), which requires referring providers to consult appropriate use criteria (AUC) prior to ordering advanced diagnostic imaging services—CT, MR, nuclear medicine and PET—for Medicare patients. The federal Centers for Medicare and Medicaid Services (CMS) will progress with a phased rollout of the CDS mandate, as the American College of Radiology (ACR) explains on its website, with voluntary reporting of the use of AUC taking place until December 2019, and mandatory reporting beginning in January 2020.] And I don’t think the imaging marketplace is anywhere prepared to manage value-based care yet.

Meanwhile, we’re seeing ongoing consolidation among vendors: for example, Intelerad has just acquired Clario. [As announced on Nov. 25 in a press release published on Business Wire, the Montreal-based “Intelerad Medical Systems™, a leader in enterprise workflow solutions, today announced the acquisition of Clario Medical, a zero footprint worklist company based in Seattle, Washington. The combined product offering will augment Intelerad's robust and highly scalable enterprise imaging solutions with Clario's rich, zero footprint worklist, satisfying the demanding needs of rapidly growing radiology practices and health systems.”] Clario was the last remaining independent worklist management/workflow company. Medicalis and Primordial had been the last two others, before being acquired by Siemens and Nuance, respectively. So all of that independent workflow capability is gone. But people perceive that even though Medicalis is now a part of Siemens and Primordial is a part of Nuance, that they’re available for third-party applications. They’re viewed as vendor-agnostic solutions, even though they’re part of bigger companies.

Is anyone buying PACS [Picture Archiving and Communications Systems] anymore outside of pure replacement needs?

Probably not. The only real reasons now that people are purchasing PACS systems any longer are replacement or upgrade. The one that’s on fire has been Visage [the Richmond, Victoria, Australia-based Visage Imaging]; they picked up Mayo Clinic last year and so everything in all of Mayo is now running off Visage. They’ve replaced their legacy GE and Siemens systems. They’ve just announced Partners in Massachusetts. So they’re on a roll.

Why is that?

I think people like their product, it’s scalable, and they’ve got a great user interface. It’s a viewing environment, not a complete PACS. They rely on third parties for the archive. They don’t address the vendor-neutral archive, they’re just about the front-end viewing. And they use third parties like Primordial or Medicalis for workflow, and just focus on the viewing aspect.

The other one that’s on fire is Sectra [the Linköping, Sweden-based Sectra AB]. Philips used them for PACS over ten years ago, and when they bought Stentor, they dropped that relationship. But only half of the sites that had Sectra went with Philips, half stayed with Sectra. And they’ve picked up HAP [the University of Pennsylvania Health System] in Philadelphia, and City of Hope in California. They never used to get invited to the table for the big deals. And the University Hospitals in Cleveland is their showcase. And now that they’ve got some of those big university hospitals, for PACS, they’re getting other deals.

So we’re seeing changes in the lead [PACS] vendors in some cases. Visage is a clear example because they’ve had so much success; Sectra is up and coming—they’ve always been strong in mammography, and they’re leveraging a lot of that technology now. Change Healthcare had some issues in terms of that transition from McKesson to change. They haven’t kept pace; but I think they can easily recover. They’re moving, interestingly enough from their dedicated relationships, and they have a relationship with Google and are going exclusively with Google Cloud, so over the next few years, their product line will change considerably. The same is true with Intelerad: they’re pushing heavily into cloud structure, which is why they acquired Clario. IBM has gotten more realistic. They do have a couple of pieces out there that are current, release product. Last year, it was a lot of smoke and mirrors and promises; this year, they legitimately have some products out there.

The fact is that tTe AI market today is like what the PACS market was fifteen years ago—very crowded. There are something like 50 players out there; it will shake out over the next several years.

What will make some succeed and some not?

I think it’s going to be the value of the product, and also the extent to which the vendors will make their products flexible in terms of being interfaced with others, so there’s this integration aspect, folding into vendor A, vendor B, vendor C, etc. So for a third party, the more they reach out and create relationships, the more successful they’ll be. A lot of it will come down to clinical value, though. Watson has had problems in that people have said, it’s great, but where’s the clinical value? So the ones that succeed will be the ones that find the most clinical value.

This is your forty-second RSNA. When you look at the trajectory of last ten years and what’s ahead, what do you see happening in the next few years?

I think the first push of AI right now is in the context that some vendors have described it as enabling the radiologists to become more efficient. That’s the primary, initial set of tools. But that’s the clinical set of tools. The next wave will go beyond the clinical to the operational, making the department more efficient, and being supportive of value-based care.

What should healthcare IT leaders be focused on right now, as they look at this market?

Well, the other aspect of this is that more and more of this technology, on the imaging side, is moving to the cloud. And that’s part of the struggle of this: how are they going to manage that, in terms of security and all the other issues they worry about, while maintaining ownership of their data?

Are there any dangers or cautions for IT leaders to consider in the next few years?

I think the challenge lies in asking how much to focus on the EHR [electronic health record], versus how much to focus on other areas.  Some of these cardiology solutions are reporting modules. Cardiology has looked unfavorably on cardiology  PACS systems, because they haven’t proven to be full-fledged cardiovascular information systems. Many providers have tried to make cardiology PACS systems work as full cardiovascular information systems. For example, one major EHR system has a cardiology solution that just collects data, but doesn’t manage the images. So the IT people think they’ve got a solution, but from the standpoint of cardiologists, they don’t; it’s not robust enough to serve all their needs. And cardiology has come out of disparate systems, EKG, vascular, ultrasound, a hodgepodge of systems, and no single environment. And over the last ten years, those have evolved to provide a true cardiovascular IS. GE’s done that, Fuji’s been transitioning to that. Lumedx [the Oakland, Calif.-based Lumedx] really has proven itself to be the gold standard in that area; they started with the databases, and then expanded off that to do the reporting; they do the registries. So they have full-service capability. They acquired a PACS vendor. They have a relationship with a vendor for the hemodynamic data.

On a scale of 1 to 10 in terms of optimism versus pessimism, in terms of imaging informatics moving forward to where it needs to go, where would you say you are right now?

I guess I’d say maybe a “6.” One of the things I’ve done is to create a schematic that I’ve been sharing with vendor executives this year on the exhibit floor. It has to do with the integration of various capabilities. On the one hand, you’ve got one set of capabilities that are fairly well established—the modalities, PACS, RIS [radiology information systems], EHRs, and advanced visualization. Then you’ve got emerging capabilities, including analytics, AI, workflow orchestration, CDS [clinical decision support], and referral management. How will vendors integrate all of those capabilities on behalf of their customers?

Every vendor has a slightly different strategy. But for them to succeed, they’ll have to figure out a strategy to enable them to do all of those things, either by themselves or through others. And even as far back as the modalities, people are starting to build AI into the modality. For example the patient moved [residences]; what do I do. Do I have to repeat images or not?

Ultimately, then, vendors will have to move towards a new level of robustness?

Yes, they’ll have to figure all of this out in terms of a changing customer mix. So Advocate [the Downers Grove, Ill.-based Advocate Health Care] and Aurora [the Milwaukee, Wis.-based Aurora Health Care] are now together, for example [on April 2, the two systems merged into a 27-hospital, $11-billion-in-revenues integrated health system, the tenth-largest in the U.S.] And they’re working off two different Epic EHR systems. Advocate concentrated on GE for PACS; Aurora is focused on McKesson/Change for PACS. So how will they contend with that and move forward? If you think of the workflow, why shouldn’t a radiologist sitting in Milwaukee be able to read a case down in Chicago? So because of consolidation, it’s a different picture than five years ago. So the workflow orchestration element is huge. How do I now divvy up that work between Advocate and Aurora? How do I provide the information from the EHR that accompanies the images, to make that information available? The vendors are wrestling with this. They haven’t yet realized that their customer base has changed.

 

 


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